Ry Willis Bergum, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

0024181720 Issued in VA

Practice address

12300 Washington Hwy
Ashland, VA 23005-7646

Phone

(804) 365-4200

Fax

(804) 365-6639

NPI assigned

Jun 29, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hanover County Board of SupervisorsGroup PAC ID 8527968742, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Hanover County Board of Supervisors

  • Mental Health Counselor
  • Ashland, VA
  • NPI 1104858653
  Medicare reassignment Care Compare group NPD
• Hanover County Board of Supervisors

  • Ambulance
  • Hanover, VA
  • NPI 1245275403
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765238400000",
    "number": "1275103459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12300 WASHINGTON HWY",
            "city": "ASHLAND",
            "state": "VA",
            "postal_code": "230057646",
            "telephone_number": "804-365-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12300 WASHINGTON HWY",
            "city": "ASHLAND",
            "state": "VA",
            "postal_code": "230057646",
            "telephone_number": "804-365-4200",
            "fax_number": "804-365-6639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGUM",
        "first_name": "RY",
        "middle_name": "WILLIS",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-29",
        "last_updated": "2025-12-09",
        "certification_date": "2025-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "VA",
            "license": "0024181720",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Ahern Becker, PHARMD
• Jamie Michelle Beckstoffer, M.ED
• Lisa M Beitz, LCSW
• James Bell
• Kathryn Bell, LCSW
• Eliot William Bird, D.D.S.
• Robert P Bird, RPH
• Elizabeth Carol Sperry Blankenship, LCSW
• Timothy Ryan Blanton
• Blossoming Willows Integrative Therapy, PLLC

• Psychiatric/Mental Health Nurse Practitioner in Ashland, VA
• Providers in Ashland, VA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.